| Baptist Memorial Hospital-desoto, Inc, | |
|
7601 Southcrest Pkwy Southaven MS 38671-4739 | |
| (662) 349-4000 | |
| Not Available |
| Full Name | Baptist Memorial Hospital-desoto, Inc, |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 7601 Southcrest Pkwy, Southaven, Mississippi |
| Authorized Official Name and Position | Gregory M Duckett (SR VP/ CLO) |
| Authorized Official Contact | 9012275233 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Baptist Memorial Hospital-desoto, Inc, 350 N Humphreys Blvd Memphis TN 38120-2177 Ph: (662) 349-4000 | Baptist Memorial Hospital-desoto, Inc, 7601 Southcrest Pkwy Southaven MS 38671-4739 Ph: (662) 349-4000 |
| NPI Number | 1194789818 |
|---|---|
| Provider Enumeration Date | 04/12/2006 |
| Last Update Date | 04/12/2021 |
| Medicare PECOS PAC ID | 5597758755 |
|---|---|
| Medicare Enrollment ID | O20040405001337 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194789818 | NPI | - | NPPES |
| 250141 | Medicaid | TN | |
| 114992105 | Medicaid | AR | |
| 00020143 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 282N00000X | General Acute Care Hospital | 13318 (Mississippi) | Primary |
| Provider Name | Aleksandar Jankov |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1003819269 PECOS PAC ID: 4082505235 Enrollment ID: I20040615000605 |
| Provider Name | John H Powell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194725432 PECOS PAC ID: 8921093675 Enrollment ID: I20040713000222 |
| Provider Name | Dharmesh S Patel |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1689651036 PECOS PAC ID: 6305818212 Enrollment ID: I20040823000951 |
| Provider Name | Raymond U Osarogiagbon |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1831181247 PECOS PAC ID: 9335198050 Enrollment ID: I20050329000947 |
| Provider Name | David W Sullivan |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1851399638 PECOS PAC ID: 3678509544 Enrollment ID: I20050712000734 |
| Provider Name | Kimberly Hardin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841392784 PECOS PAC ID: 5092738047 Enrollment ID: I20060105000495 |
| Provider Name | Istvan D Wollak |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1619919305 PECOS PAC ID: 1254335227 Enrollment ID: I20060905000491 |
| Provider Name | Sailendra Vasireddy |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1417900374 PECOS PAC ID: 3375547292 Enrollment ID: I20060907000587 |
| Provider Name | William K Walsh |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1982602785 PECOS PAC ID: 2062482714 Enrollment ID: I20080602000390 |
| Provider Name | Mary S Missak |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962507061 PECOS PAC ID: 7416015904 Enrollment ID: I20081028000478 |
| Provider Name | Magdi Wassef |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275638363 PECOS PAC ID: 9032010210 Enrollment ID: I20081028000490 |
| Provider Name | Sohail A Minhas |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1053303750 PECOS PAC ID: 0345137071 Enrollment ID: I20100217000444 |
| Provider Name | Muhammad M Mirza |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1467670984 PECOS PAC ID: 1850436411 Enrollment ID: I20100308000028 |
| Provider Name | Syed Azmi |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1922203082 PECOS PAC ID: 3577618347 Enrollment ID: I20101111000156 |
| Provider Name | Angela M Scott |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578870853 PECOS PAC ID: 1759560089 Enrollment ID: I20110404000480 |
| Provider Name | Donald S Gravenor |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1770581662 PECOS PAC ID: 4688708050 Enrollment ID: I20120104000234 |
| Provider Name | Todd Henderson |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1710163050 PECOS PAC ID: 2769520162 Enrollment ID: I20130606000579 |
| Provider Name | Amna Gul Khattak |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1528276763 PECOS PAC ID: 8123275781 Enrollment ID: I20130618000037 |
| Provider Name | Muhammad Raza |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1619198512 PECOS PAC ID: 3870762263 Enrollment ID: I20130620000245 |
| Provider Name | Yadana Kyaw |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1134393473 PECOS PAC ID: 9335380344 Enrollment ID: I20130801000835 |
| Provider Name | Osarenren Ogbeide |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1952375156 PECOS PAC ID: 7911972443 Enrollment ID: I20150130000191 |
| Provider Name | Salil Goorha |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1124241062 PECOS PAC ID: 6305907205 Enrollment ID: I20150901001148 |
| Provider Name | Rajeev Gupta |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1669602603 PECOS PAC ID: 7911137971 Enrollment ID: I20151028002802 |
| Provider Name | Drew Dill |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1578723276 PECOS PAC ID: 9335387026 Enrollment ID: I20170323001697 |
| Provider Name | Aaron John Harris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770858144 PECOS PAC ID: 0840456299 Enrollment ID: I20170911002212 |
| Provider Name | Ashley Victoria Mccurdy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811348519 PECOS PAC ID: 2961795448 Enrollment ID: I20171209000005 |
| Provider Name | Philip Edward Lammers |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1780802330 PECOS PAC ID: 0244475192 Enrollment ID: I20190225003172 |
| Provider Name | Megan Marie Crosier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902459555 PECOS PAC ID: 0547599789 Enrollment ID: I20190912002075 |
| Provider Name | David Bryan Engle |
|---|---|
| Provider Type | Practitioner - Gynecological Oncology |
| Provider Identifiers | NPI Number: 1487611760 PECOS PAC ID: 2466430798 Enrollment ID: I20210304001513 |
| Provider Name | Sandeep Rajan |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1396852273 PECOS PAC ID: 0446254957 Enrollment ID: I20230921001128 |
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